Why did twins die? Experts uncertain

February 27, 1993|By Michael James | Michael James,Staff Writer

State medical examiners are still trying to determine what caused the deaths of twin infants who were revived by their mother after they mysteriously stopped breathing Sunday in a crib in their Northeast Baltimore home.

City police say they are considering the possibility of sudden infant death syndrome (SIDS).

"We're looking at it. But it's rare in twins -- there have only been 11 documented cases worldwide," said a police investigator.

Autopsies on the 6-month-old twins, Brandon Blair and his brother, Todd, were not immediately conclusive, and medical examiners will be performing more tests to pinpoint why the tiny boys stopped breathing, police said.

"It's a very unusual case. We're exploring all possibilities," said Dr. John E. Smialek, the chief state medical examiner. "More than that, I can't say. We want to make sure it's a thorough investigation."

It will be several days or weeks before medical examiners have all the test results -- which include toxicology and microscopic analysis -- needed to make a cause of death determination.

Dr. Smialek declined to comment about sudden infant death syndrome as a possible cause of death.

In nearly all cases of SIDS, an apparently healthy baby is laid down to sleep and sometime later inexplicably dies.

The twins' mother, Kim Panufka, called a 911 dispatcher Sunday and reported the boys had stopped breathing while wrapped in a blanket in their crib at their home in the 2800 block of Hamilton Ave.

Ms. Panufka, responding to the directions given by the dispatcher, was able to get the boys breathing again. But Brandon died Tuesday and Todd died Wednesday at the Johns Hopkins Children's Center.

The odds of SIDS occurring in twins is an extraordinary rarity, to the point that statistics are not even kept, said Dr. Carole Marcus, a pediatric pulmonary specialist at the Hopkins children's center.

"There have been a few case reports [of twins dying of SIDS] in journals, but you always have to make sure there's no other cause when you have something that unusual," Dr. Marcus said.

A prevailing theory of the cause of SIDS is that the baby's brain lacks maturity in controlling breathing and heart rate, Dr. Marcus said. Some have speculated that babies sleeping on their stomachs are higher risks, although that has not been conclusively proven, she said.

It is thought to account for about three deaths for every 2,000 live births in the U.S.

According to the American Medical Association, SIDS is slightly more common among boys, particularly those born premature. (The Blair twins were born two months premature.) Three-quarters of all cases occur in babies between 1 month and 6 months of age.

Medical experts say that infants who have survived an apparent SIDS episode are at risk of another episode. Most SIDS cases have occurred during the winter and on weekends, the AMA said.